Forging Policy: How Can Doulas Improve Black Maternal Health?

It is not a new concept to have someone support women and birthing people during pregnancy, birth, and postpartum.

Doulas, or labor birth companions, typically women, have been an integral part of childbearing throughout history; they provide information, patient advocacy, and physical support. Doulas increase a person’s satisfaction with the birthing experience, raise the likelihood of having a spontaneous vaginal birth, and decrease the chances of a cesarean. As a result, doulas have erupted in popularity in recent years.

Yet the national landscape for doulas is changing rapidly. Community-based doulas, or doulas that are members of the community that they serve and share similarities in race/ethnicity or culture, are increasing in number and impact. There is also a new wave of professionalization and partnerships between community-based doulas and health care systems that are being proposed as a strategy to improve Black maternal health outcomes and decrease disparities.

How do we integrate doulas into the health care system in an equitable way?

There is a lot of momentum around developing innovative strategies to improve Black maternal health outcomes.
Noelene k Jeffers, PhD, CNM, IBCLC

This is where Noelene K. Jeffers, PhD, CNM, IBCLC, comes in. Dr. Jeffers is an Assistant Professor at the School of Nursing who studies the impact of midwives and birth center care on perinatal health, racism, and discrimination in midwifery education programs.

Soon Dr. Jeffers will bring together doulas, policy experts, health care providers, payers, and patient advocates in the Mid-Atlantic region to explore and describe important features of equitable doula- health care system partnerships.

It’s phase one of her three-phase study, “Identifying Research Priorities for Promoting Black Maternal Health Equity Through Partnerships Between Community Based Doulas and Health Care Systems.” This phase is a Black Maternal Health Week café, developed in partnership with Dr. Kanika Harris, the Director of Maternal Health at the Black Women’s Health Imperative, a nonprofit focused on achieving health equity for Black women. The project is funded through a health redesign grant from the Institute for Policy Solutions.

“The fact is that this is a very under-researched area,” says Dr. Jeffers. “Yet Black maternal health, and maternal health in general, has been getting more attention, especially in the last five years, and there’s a lot of momentum around developing innovative strategies to improve care.”

In phase one, experts will discuss pivotal questions, such as:

“What partnerships between doulas and health care systems already exist in our communities?”

“What is our shared vision for equitable and impactful partnerships?”

Phases two and three of the study will include surveys to develop research priorities and specific research questions that need to be tackled.

“States, payors, everyone is trying to identify innovative ways to bridge the gap between doulas and health care delivery in hospitals and outpatient clinics,” says Dr. Jeffers. The goal is for this study to inform policy and practice that they will create, ultimately promoting Black maternal health. “This is a dynamic time and evidence-based research can help us move forward with intention.”

Doulas Take on Racism in Care

“If we want to improve Black maternal health outcomes, we have to start acting like a functioning ecosystem. An ecosystem includes individual parts that are each doing their own work but are doing so in dynamic relationship with each other and in service to the system’s larger, overarching goals.”

Black women and birthing people are 2.6 times more likely to die during pregnancy or from childbirth-related causes than White women. They are also 1.5 times more likely to have a baby born preterm, and 2.4 times more likely to have their infant die in the first year of life. These statistics remain, regardless of income, education, or socioeconomic level.

Implicit bias and discrimination in the health care setting play a role. Black women and birthing people have repeatedly expressed experiences of racism in care where providers do not listen or treat them differently. It is a harmful, trickle-down effect of structural racism, which is deeply ingrained in our health care system.

Community-based doulas and their culturally specific approach to patient advocacy and personalized care could be a perfect fit solution.

Dr. Jeffers’ study will assess the status of integrating doulas into the health care system, describe conditions that foster equitable partnerships, and enhance our understanding of the research gaps.

“There is an urgent need for a more focused research agenda to build evidence around how doulas and healthcare systems can partner effectively to improve Black maternal health,” says Dr. Jeffers. “It’s really powerful to work together with the larger maternal health community to set the research agenda that is more usable and more likely to effect the policy changes necessary for lasting change.”

About the Author: Sam DiStefano

Sam DiStefano is the Social Media and Digital Content Coordinator for the Johns Hopkins School of Nursing. Sam works to bring the latest from JHUSON straight to your social media feeds and online reading.